My First Vanuatu "Cesar" and Namesake

I've had a few very busy days at the hospital, the kind that you just work through lunch because there are so many women waiting to be checked, admitted, or are about to push their babies out. A few women and their experiences are to share......

I worked with a young, first time mom all day Monday and returned Tuesday to find her still at the hospital in labor. This was one of those primip (first time) births....... all you birth related folks out there know exactly what's to come.

Her latent labor started Friday and she came into the hospital when her contractions picked up around 8 am Monday morning. When I first checked her that morning, her baby was still floating very high in her pelvis, completely unengaged. Her cervix was dilated to about 3 cm and it was partially effaced (thinned out). Not much change happened over the course of Monday and when I retruned Tuesday she was 6 cm and her baby was engaged in her pelvis, all good signs that her labor was progressing. We suspected that her baby was also positioned posterior, which is a difficult position for any baby to come out, but especially with a first timer. As Tuesday continued, her contractions were irregular and spaced out, so the doc recommended we rupture her membranes and start an IV drip with syntocin (aka pitocin) to augment her labor. Upon rupture her water showed moderate meconium (the babe's first poop- a sign of some form of stress somewhere along the way). Her contractions did pick up more regularly with the Syntocin, but she started having the despised uncontrollable, premature urge to push while her cervix remained at 6cm. This mom was exhausted and as I have seen SOOOOO many times before with this same situation in the States, I was was hoping I could see a different outcome. Alas, the doc decided it was time to do a "Cesar"- C-section. I felt the same way I always do after these long labors, often several days, ending in a Cesar. I was able to scrub up for the surgery and receive the baby after he was born. There was a fabulous anesthesiologist from Australia running the show- a very personal, kind being, just the kind of person you want to be watching over you while you're having major abdominal surgery.
The surgical theatre was an interesting experience. Although I've never attended a Cesar in the US, I have observed them while in Costa Rica. This experience seemed overall the same, but it seemed more relaxed in lots of ways- not in safety terms, per se...... hmmmmm, not even sure how to describe the differences. I looked up at one of the surgery nurses in her scrubs, her mask, and her hair wrap, and amongst all the covering, there i saw a little white flower tucked behind her ear. Yes, in a way, that seems to sum up the experience...... if that makes any sense at all in this two dimensional story.
The surgery was a success and a sweet baby boy who had been not only posterior, but had a hand up near his head with the cord around his arm, was born..... gives some reasons as to why he couldn't come down or turn around to get out vaginally.

The Cesar rate here is around 5%, on average about 10 Cesars per month. During the 24 hour period leading up to this young mama's surgery, we had 2 others, filling nearly a third of those for the month in one day. One Cesar was for fetal distress with every contraction, and another for a pair of twins who had thick meconium and were showing some distress. As always, things seem to go in waves, and often in sets of 3.

Yesterday, Elias and I spent our first day together at the hopsital, as he just arrived on Tuesday afternoon. It was lucky that he was there because only one of the two midwives were there because the other had a family member pass away. So it was going to be just me and the other midwife, until Elias showed up. We had 4 births between 11:30am and 3pm. I caught the first 2, Elias took the next, and a student nurse who came on for the next shift took the last. I particularly wanted to write about the second mom that I worked with because she is what we call a Grand Multip. This was her 9th pregnancy. She has 7 children: 5 boys, 2 girls, and one of her pregnancies ended in a stillbirth due to a cord complication. She was planning a tubal ligation after this birth, so this was her last baby and she had recently found out that it was another girl.

She was 3cm upon arrival in the morning and when we watched the babe's heartrate on the CTG machine, we saw some decelerations with her contractions. At that point, her contractions were about 10 minutes apart, but it was undeniable that the decelerations were happening with the contractions. We moved her from side to side, started an IV to give fluids (especially as a preventive for postpartum hemorrhage since a uterus that has been stretched 9 times may have less ability to contract after the birth to stop the bleeding), and we broke her waters to see if there was meconium in her fluid, which there was a light amount. We kept her on the CTG to monitor the babe and meanwhile ran off to catch the first babe of our shift. At some point the midwife moved her into the other birth theatre, and she was just walking around, having a few more contractions here and there. I was finishing up with the postpartum events of the other babe, fondly referred to as "stickem and scalem"- giving them their injections and weighing them- when I heard lots of commotion and moaning. I ran back into the theatre literally just in time to put my hands on the babe's head as she came out, to keep her from shooting out like a cannon! She took awhile to come around and breathe, but within a minute with some good stimulation, she was breathing fine. I took her out for her pokes and to be weighed and when i returned, the mom told me that she was going to name her baby Molly. I think after 9 kids she either ran out of names, or she appreciated my care ;) I told her that there was a high probability that this little Molly would be a midwife someday, since there are so many of us "Molly the Midwife" from Bastyr. Although some women here have no interest in seeing their babes after they are born, this mom, even after 8 other births, was excited to see and asking for her baby. That's me and this little "Molly-the-Midwife-to-be" while she received her first swim-swim (Bislama for bath)!

Today I'm taking it easy and heading out for a kayaking adventure..... with a full moon in the coming days and the change in pressure we are experiencing, it's likely to make the babies drop!